CA19-9 as a non-invasive marker for disease activity in Hepatitis B patients: is there any role?

The combined elevation of tumor markers carbohydrate antigen 19-9 (CA 19-9) and carbohydrate antigen 125 (CA 125) has been shown to be associated with the severity of liver fibrosis in patients with liver disease. We assessed the association between CA 19-9 and viral hepatitis B activity which will allow us to know the usefulness of CA 19-9 as a surrogate marker for the disease activity in hepatitis B patients. Methods: A prospective study involving 60 patients with hepatitis B surface antigen positive carrier was performed. These patients were divided into 2 groups according to HBeAg positivity. Tumor marker CA 19-9 was determined using routine laboratory methods and correlated with the disease activity by measuring hepatitis B viral DNA (HBV DNA) and serum alanine transaminase (ALT) and aspartate transaminase (AST) levels. Results: Eleven (18%) were HBeAg positive and 49 (82%) were HBeAg negative. The mean (standard deviation) age in the former group was 40.7 (11.7) years and in the latter group was 40.8 (12.5) years (p = 0.98). There was no significance difference between the two groups with respect to the levels of serum ALT/AST, HBV DNA and CA 19-9. There was no significant correlation seen between CA 19-9 and serum ALT/AST. It was the same with the levels of HBV DNA. Discussions and conclusion: The use of CA 19-9 as a non-invasive marker for disease activity in patients with hepatitis B infection was not useful. There was no role of CA 19-9 in hepatitis B patients to assess the disease activity

A Study of Paraoxonase (PON-1) Activity and Concentration in Coronary Artery Disease Patients in Kuantan, Pahang

Introduction: Paraoxonase 1 (PON1) is a high density lipoprotein (HDL) associated enzyme that is known to inhibit oxidative modification of low density lipoprotein (LDL), thus implicated in the pathogenesis of atherosclerosis and coronary artery disease (CAD). It has been suggested that the variability in this enzyme activity is attributed to polymorphism in PON-1 gene. Nevertheless, even within the same genotype, PON-1 activity and concentration has been shown to vary widely between the different individuals. Therefore, recent studies in various populations have emphasized on the importance of measuring the PON1 activity and concentration in assessing the risk of CAD. The data of such study is however scarce in Malaysia. Objective: The aim of this study was to compare the PON-1 activities and concentration between the healthy controls and CAD patients. Methods: A comparative cross sectional study was carried out on 187 CAD patients in Tengku Ampuan Afzan Hospital, Kuantan and 188 healthy controls. Serum samples were analyzed for PON-1 activities towards paraoxon and phenylacetate as well as for HDLcholesterol. PON1 concentration was expressed as PON1 activity per mmol of HDL. Results: Serum PON-1 activities as well as concentration were found to be lower in CAD patients than in the healthy controls but the results were not significant (p > 0.05). Conclusion: Our finding suggested that PON1 activities and concentration were similar between healthy control and CAD patients in Kuantan, Pahang. A multicentre study may be required to confirm our findings in Malaysian population

Relationship between levels of thyroid stimulating hormone, age, and gender, with symptoms of depression among patients with thyroid disorders as measured by the Depression Anxiety Stress Scale 21 (DASS-21)

Objective: The aim of this study was to investigate the correlation between levels of depression symptoms and age, thyroid-stimulating hormone levels, and stressful life events of the participants. Method: Patients above 18 years old, with any thyroid disorders, and without psychiatric disorders were included in this study. All participants completed the Depression Anxiety Stress Scale 21 (DASS-21). The depression symptom score was calculated and interpreted as follows: less than 9: no depression; between 10 and 13: mild depression; between 14 and 20: moderate depression; between 21 and 27: severe depression, and more than 28: extremely severe depression. Results: The total number of participants in this study was 199. There was no correlation between age, thyroid stimulating hormone, and the DASS score. There was also no significant difference in the DASS-21 score between genders. However, there was a positive correlation between depression symptoms and stressful life events (r = 0.201, n = 199, p < 0.05). Conclusions: These findings would suggest that increased depression symptom scores correlate with increased stressful life events. A larger study should be undertaken to confirm these findings

Safety and efficacy of basal bolus and premixed insulin intensification regimes in the management of type 2 diabetes mellitus : A 13 year narrative review of literature

Background: Type 2 Diabetes Mellitus (T2DM) is a chronic condition due to insulin resistance or relative insulin deficiency. Although insulin intensification regimens are commonly prescribed for the management of T2DM, there is uncertainty regarding their optimal use. We conducted a 13 Year narrative review to compare outcomes of these regimens in the treatment of T2DM. Method: We searched electronic databases (PubMed, Scopus, Proquest and Google Search), and “grey literature” from January 2000 to December 2013 to identify studies comparing insulin intensification regimens. Results: Out of 17 studies identified, we only included 10 studies specifically comparing Basal-Bolus regimens (BB) versus Pre-mixed Insulin Regimens (PM). Seven trials comparing regimens other than the studied regimens; with study duration lesser than 12 weeks; or involving Type 1 diabetes mellitus patients were excluded. The outcomes measured were divided into safety and efficacy parameters. Among the safety outcomes measured were Hypoglycemia, Weight Gain, Quality of Life (QoL), and other Adverse Events (AE). Whereas, efficacy outcomes measured were Glycosylated Haemoglobin (HbA1c), Fasting Plasma Glucose, Daily Plasma Glucose, Post Prandial Plasma Glucose, Carotid Intima Media Thickness (IMT), Adinopectin Level, 1-5-anhydroglucitol(1,5-AG),Total Daily Insulin (TDI) Dose and Cost. Mixed results were discovered among all the parameters measured favoring in between BB and PM regimens. Conclusion: We found that BB regimens showed better glycemic control especially in terms of the primary endpoint of HbAlc but at the expanse of significantly higher TDI dose, weight gain, and further increase in cost of treatment. Whereas, all other parameters measured were comparable between regimens. Locally, conventional human insulin is still the mainstay of insulin therapy in health facilities nationwide. Yet, none of the identified studies compared head-to-head human insulin in both arms. Thus, future researches comparing non-analogue insulin may be conducted to gather new evidence in the field of diabetes locally

Depression symptoms in patients with thyroid disorder at the tertiary hospital in northern region of Malaysia

Introduction: Thyroid disorder patients have a high risk to experience depression symptoms resulting from the thyroid hormone fluctuations. The aims of this study were to evaluate the occurrence of depression symptoms and to analyze the association between depression symptoms and social-demographic of the patients affected by different thyroid disorders. Methods: This was a cross-sectional study of one of the non-profit hospitals in the northern region of Malaysia. Depression symptoms were measured using the Depression Anxiety Stress Scale-21 (DASS-21). Socio-demographic characteristics of the patients were gathered using the questionnaire. Patients with any thyroid disorders, above 18 years old and did not have any psychiatric disorders were included in this study. Results: The total numbers of subjects in this study were 199. The female consisted of 76.9% (153). The mean age was 46.32±15.16 years. Regarding the thyroid disorder; 35.2% (70) had hyperthyroidism, 23.6% (47) had goitre, 14.1% (28) had hypothyroidism, 14.6% (29) had autoimmune thyroid disorders while thyroid cancer was found in 12.6% (25). Determination of depression symptoms showed that 85.9% (171) had no depression, 6.0% (12) and 4.5% (9) had mild to moderate depression respectively while severe depression was found in 3.5% (7) cases. Age and patients, those not living alone significantly associated with depression symptoms (p<0.05). Conclusions: These findings would suggest that some of the thyroid patients had depression symptoms. In addition, the patients in middle aged and staying with family seem to have depression symptoms. Further studies should be performed, in order to confirm these findings

Bilateral facial nerve palsy secondary to an atypical presentation of Gullain-Barré syndrome

Bilateral simultaneous facial nerve palsy is an extremely rare clinical entity and may occur in association with a variety of neurological, infectious, neoplastic or degenerative disorders. We describe a patient, who presented with facial diplegia and normal reflexes on examination. During the entire hospitalization, he developed no motor weakness and remained ambulatory. Whether treatment is warranted for this and other milder variants of Gullain-Barré syndrome is also discussed. Atypical presentations with preserved or brisk reflexes, can be a diagnostic dilemma

Analgesic synergism of gabapentin and carbamazepine in rat model of diabetic neuropathic pain

Purpose: To evaluate synergy in the analgesic effects of a combination therapy of carbamazepine (CBZ) and gabapentin (GBP) in diabetic neuropathic pain. Methods: Neuropathic pain was produced in rats by a single intraperitoneal injection of streptozotocin (STZ) at 60 mg/kg. CBZ, GBP, and their combination were orally administered at varying doses (GBP 30 - 180 mg/kg; CBZ 20 - 40 mg/kg) comparable to their therapeutic doses in humans. Nociceptive responses in the diabetic rats were assessed using hot plate test. Results: Hot plate latency significantly increased with oral administration of GBP at a dose of 180 mg/kg when compared with control group (p < 0.05), while at a dose of 90 mg/kg, the increase was not significant. Oral administration of CBZ at doses of 20 and 40 mg/kg did not produce any significant impact on hot plate latency. However, a combination of GBP at 90 mg/kg and CBZ at 20 mg/kg produced significant increase in latency, compared with control group and other groups (p < 0.05), except the group that received 180 mg/kg GBP. The combination of low dose GBP 30 mg/kg and carbamazepine 30 mg/kg had no significant effect on latency (p > 0.05). Conclusion: The results obtained in this study provide useful information on the combination therapy of GBP and CBZ, which may be applied in the treatment of pain in diabetic neuropathy

A cross-sectional study on the quality of life of patients with peripheral diabetic neuropathy pain in Hospital Tegku Ampaun Afzan, Kuantan, Malaysia

Purpose: To evaluate the quality of life of patients with peripheral diabetic neuropathy pain (PDNP) in Hospital Tegku Ampaun Afzan (HTAA), Kuantan, Malaysia.Methods: Ninety (90) participants were selected from the Medical Outpatient Department (MOPD) clinic of HTAA. The study adopted a cross-sectional design, and the self-administered Douleur Neuropathy 4 (DN4) and Audit of Diabetes-Dependent Quality of Life (ADDQoL) questionnaires were used for data collection.Results: The negative impact of diabetes on QoL was clearly reflected in the fact that every domain had a negative mean value. Overall, 27.8 % of the participants reported that DM negatively affected their QoL and 37.8 % expressed the opinion that their QoL would have been higher if they were not diabetic. QoL correlated with marital status and age, with married participants and participants in the age range 50 - 59 years old showing QoL negatively affected (p &lt; 0.05) by DM with PDNP. Apart from diabetes type, all other characteristics significantly affected participants QoL as reflected by the various related domains (p &lt; 0.05).Conclusion: Based on the findings of this study, it seems that individuals with diabetes and PDNP have a low QoL, with regard to “freedom to eat”, “freedom to drink”, “physical health”, “family life”, and “living condition”.Keywords: Quality of life, Diabetes, Peripheral neuropathy pai

Depression, anxiety and stress levels during COVID-19 pandemic among frontliners of IIUM hospital and Kuantan campus and its associated Factors

Introduction: �e COVID-19 pandemic has instigated a substantial physical and psychological burden on the frontliners globally, leading to physical and psychiatric illnesses, reduction in productivity and burnout. Assessing their mental health status is essential in providing e�ective and e�cient mental health care. Objective: To investigate depression, anxiety, and stress levels, and associated factors among the frontliners of International Islamic University Malaysia (IIUM) Hospital and Kuantan Campus during the COVID-19 pandemic. Methods: A cross-sectional study was conducted among 261 frontliners working in IIUM hospital and 125 from the Kuantan campus from March 2021 to March 2023 using a self�administered validated DASS-21 questionnaire for depression, anxiety and stress. �e data were analyzed using descriptive statistics, Chi-Square and Fisher’s Exact tests. Results: Among the 386 respondents, 82.1% were categorized as clinical frontliners, 65.8% were female, and 65.8% married. �e overall prevalence of depression was 15.8%, anxiety was 29.5%, and stress was 9.3% among the frontliners. �ey were not di�erent statistically between the clinical and non-clinical frontliners; or between the IIUM Hospital and on-campus frontliners. �e frontliners with post-traumatic event had a signi�cant association with depression and anxiety (p <0.001 and 0.001, respectively), and those with chronic disease(s) were signi�cantly associated with anxiety (p=0.034). Conclusion: More than one-fourth of frontliners su�ere

Depression, anxiety and stress levels among frontliners of hospital-based (SASMEC) and university campus (IIUM Kuantan) during covid-19 pandemic and its associated factors

The COVID-19 pandemic or endemic has instigated a substantial physical and psychological burden on the frontliners globally, which lead to harmful consequences on emotional and mental health such as physical and psychiatric disorders, reduction in productivity, loss of commitment and burnout. Hence, assessing their mental health status is essential as an access point in providing appropriate mental health care. This study aimed to measure depression, anxiety, and stress level and their associated factors among the frontliners working at the International Islamic University Malaysia (IIUM) Kuantan Campus and SASMEC-Hospital during the COVID-19 pandemic